POS1483 IS EARLY REMISSION A PREDICTIVE FACTOR FOR STEROID-FREE REMISSION IN SYSTEMIC LUPUS ERITHEMATOSUS? A REAL-LIFE EXPERIENCE FROM A MONOCENTRIC COHORT
Authors: D. Zucchi, C. Tani, F. Trentin, V. Signorini, C. Stagnaro, L. Carli, F. Ferro, E. Elefante, C. Cardelli, D. Schilirò, M. Maffi, G. Cascarano, L. Gualtieri, A. Valevich, M. Mosca
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Glucocorticoid (GC) dose minimization and, if possible, complete withdrawal is one of the main targets in the daily management of Systemic Lupus Erythematosus (SLE). <h3>Objectives</h3> to describe frequency and clinical characteristics of SLE patients in GC-free remission in a real-life setting and to identify predictive factors for achieving GC-free remission. <h3>Methods</h3> this is a retrospective analysis of prospectively collected data from a monocentric SLE cohort. The following variables were retrieved: demographic data, cumulative organ involvement; at last observation: disease activity (SLEDAI-2K score), ongoing therapy, disease state (remission defined according to the 2021 DORIS criteria) and organ damage (SDI score). Disease state at 1 year from disease onset was also recorded. <h3>Results</h3> from our cohort, a total of 390 SLE patients had at least 1 year of follow-up and complete clinical data to be included in the analysis; of these, 142 (36.4%) were in GC-free remission at the last evaluation, and 44 (11.3%) were GC-free for 5 years (Table 1). The mean follow-up duration was 10.5 years (min 1-max 41). No significant differences were found with regard to age at disease onset, disease duration and organ involvement between the GC-free remission group (GC-) and the other SLE patients under GC treatment (GC+). Patients GC- were less frequently taking immunosuppressants (IS) (28.9%, vs 43.5% p&lt;0.01) or biological drugs (6.3% vs 20.2% p&lt;0.01) and were more frequently under HCQ treatment (85.2% vs 75.8%, p=0.03) at last observation. Being GC- at last observation was associated with a significantly lower organ damage with respect to GC+ (mean SDI 0.7 vs 1.5, p&lt;0.01); significant differences regarded cardiovascular (CV) events (4.9% vs 12.1%, p=0.01) and osteoporosis (OP) (12.7% vs 27.0%, p&lt;0.01) were also found. Overall, 212 patients were in remission after 1 year from disease onset (78.2% in GC- and 57.2% in the GC+) and this condition resulted significantly associated with GC-free remission at last evaluation (p&lt;0.01). At multivariate analysis, being in remission at 1 year resulted an independent predictor of GC-free remission (OR=2.06, p=0.02); the multivariate analysis also confirmed that GC- patients were less likely on IS or biological treatment at last evaluation (OR 0.46 p&lt;0,01 and OR 0.20 p&lt;0.01, respectively). <h3>Conclusion</h3> these data suggest that GC-free remission is an achievable goal in SLE patients with today's drugs, and in our cohort GC-free remission is also a IS-free remission in most of patients. Our study also confirms that GC withdrawal has important advantages in term of organ-damage sparing. Of note, the early achievement of remission during the disease history is associated with a good probability of GC withdrawal over time. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.